Continued Aggression

In the continuing saga of last week's strep, there are some updates. 

The weekend was calm and I was hopeful that the antibiotics had killed off crazy behavior.  Sunday was the first time in over a week that the boys seemed like themselves.

Ben saw the ENT for an appointment scheduled after his last ear infection....since July he has had 4 ear infections and 2 bouts of strep throat.  The ENT recommended another set of ear tubes and a tonsillectomy.....This will be Ben's 3rd surgery, the 4th ENT surgery between the two boys, and the 5th surgery I have managed as a mother in a little over 3 years.

Then all hell broke loose yesterday afternoon at gymnastics when Liam was asked to sit up while waiting his turn (he was laying down).  He said no and was asked to sit out a moment and then he HIT his gymnastics coach.  His coach brought him to me, and I was trying to calm him down......Not realizing that class was almost over.  Suddenly, we were surrounded by people and Liam from being angry to a full blown sensory meltdown.

He began to hit me and was grabbing my necklace.  I was trying to wait until everyone left so I'd have more space to move him out.  He realized Ben left his socks on the floor and became upset about that.  He overheard friends were going for doughnuts and became furious with me for saying we could not go.  Ben actually cooperated and found his socks.  I held Liam while pinning his arms to stopp him from hitting or choking me while I put on Ben's socks and shoes.  I left Liam's shoes off as I saw no way to put them on.  Then I carried 50 pounds of flailing, kicking, hitting my face Liam and my diaper bag while holding onto to Ben's hand.....how?  I don't know but I managed. 

Once in his 5 point harness, Liam began to throw anything in the car he could reach and kept grabbing Ben's hand.  I was terrified he'd break Ben's fingers. 

The meltdown lasted about 20 minutes though it felt significantly longer.  It ended as suddenly as it started.

That is the worst meltdown he has had in about a year, since this: http://routhierfam.blogspot.com/2012_01_01_archive.html  But the aggression is so unlike Liam.

So is it autism or is it PANDAS?

Difference between a meltdown and a tantrum

So is it a tantrum or a meltdown?

The SPD blogger network has an excellent post describing the difference between a trantrum and a meltdown in this blog post. The basic difference boils down to a tanturm being a manipulative fit and a meltdown being an emotional response to an unmet need.

As I mentioned earlier today, Liam was due to visit a Kindergarten class as part of his speech therapy at preschool today. Hint one: change in routine.  He got off the bus and was a bit emotional, immediately asking to play with our neighbor.  I asked about his visit to the kindergarten classroom and he told me he didn't go as all the kids were gone snowshoeing.  Then he started to ask me if he could snowshoe.

We get inside and I see an e-mail from his teacher, and it mentions that today did not go well.  Liam DID go to the class when they knew the kids would be out of the room to the meet the teacher.  When he returned to his normal classroom, he started to meltdown and could not communicate why to his teacher.  Then they were out of time and he came home.

So I ask Liam if he got upset at school.  He said something about a van and then fell into a meltdown.  The video above was taken 5 minutes in.  I literally could not get video any sooner as Liam was trying to kick me and was hitting himself on the head.  I waited until he was not harming either himself or me and then took this video.  I never was able to calm him down using the techniques his teacher uses, so I sent him to his beanbag.  It took him about 5 minutes but he calmed down and came back to me.

I let him talk for a bit about other things for a few minutes before I tried again to ask why he was upset.  He tearfully told me "I didn't finish coloring my van." Then he started crying again.  This time he accepted cuddles and calmed down as I held him.  From what I gather as Liam was not able to elaborate, visiting the Kindergarten room interfered with him finsihing an art project.

Clearly, Liam was not tantruming or trying to manipulate anyone into meeting a want.  Instead, he was in emotional distress.

Edited to add that I just heard back from his teacher, as I described what happened when he got home, and I was trying to figure out what he was saying about the van.  This is her response (and again, I love his teacher and am sad we are moving as she would be a great resource for his K teacher):

"You know...come to think of it, Liam got upset once before when we didn't finish our art project before it was time to go home. So maybe that's all that it was. We were doing a picture of a van in our writing books :-)
But from now on, she'll be taking him a little later in the day and his work should be done (but these are the types of situations I need to continue to set up to get him used to change and so we can continue to talk through problems that will arise. He understands the concept of calming down by placing his hands on his belly, naming the emotion, and taking belly breaths to get through things that are stressing him out. But I want him stress free for his visits to the Kindy classroom so I'll set up other times when he'll be in the classroom here. ) I'm sure the next visit will go better because there will be kids in there. Plus, once he's worked through something with us, he can usually handle it the next time it happens :-)"

Seeing him through the eyes of others

I was reminded yesterday why I don't post about Liam's progress: I am always afraid it will be contradicted the next day and that is exactly what happened. Liam's SLP brought him out after his session and was trying to talk to me about Liam's session. She had asked Liam what we did on vacation and he said something about the forest and alligators; she wanted to know if we went to a zoo or something. I haven't blogged yet about our trip to Homer, Alaska, but I assure you in Alaska there are no alligators and on the Homer spit (about 4 miles long and 1.5 miles wide and surrounded by water), there is no forest. In the middle of this frustrating conversation where I realized Liam STILL cannnot convey a simple answer to "what did you do last week on vacation?" a cell phone rang in the waiting room.

To be polite, the woman whose phone rang went into the entryway so as not to disturb me and the SLP.   Her 2 year old followed her and took with him a toy from the waiting room. Liam knows the rules are that toys stay in the waiting room (he sometimes wants to take the toys home). Instead of telling me or the SLP that he was upset, he simply started crying and screaming. We couldn't figure out why he was upset for a couple minutes. In the meantime, Ben freaked out because Liam was crying and I was holding him.   Now, Liam was partially crying because Ben's crying was upset him and he could not calm himself down about the fact the toy had been in the entryway.

The woman and her son came back into the waiting room, looking confused as to why Liam was so upset. This only upset Liam more, and he started pacing around the room, circling the toddler, and rushing up to him, getting in his personal space, all while screaming at the top of his lungs and flapping his arms. It was one of the those moments where I see Liam as how he appears to other people, especially as his behavior was so characteristically autistic. I have seen that behavior several times from older, lower-functioning teen-agers in that same waiting room. I could see the worry on the mom's face as she didn't know Liam and she didn't know if he'd hurt her little boy (who was smaller than Ben). Liam was staying in between her and her son. Bless her, as she didn't interfere and trusted me and the SLP that we would control Liam. I was confident he wouldn't hurt the little boy, but I would have been just as worried in her place. Liam was clearly out of control. I kept trying to get him in a bear hug to calm him but he would scream louder and wiggle from my grasp and go back to rushing up on the little boy. Finally, the little boy gave Liam the toy, and eventually through lots of quiet talking, Liam calmed down.  He didn't want the toy; he just didn't want it in the entryway.